%0 Journal Article
%T Technical aspects of flap fixation after mastectomy for breast cancer: Guidelines for improving seroma-related outcome.
%A Spiekerman van Weezelenburg MA
%A Aldenhoven L
%A van Kuijk SMJ
%A Beets GL
%A van Bastelaar J
%J J Surg Oncol
%V 127
%N 1
%D Jan 2023
%M 36173092
%F 2.885
%R 10.1002/jso.27109
%X <B>OBJECTIVE: </B>Previous studies have identified the added value of flap fixation in reducing seroma formation and its sequelae after mastectomy. The seroma reduction after mastectomy (SAM)-trial proved that sutures were superior to tissue glue. In this article, we will elaborate on the results of the SAM-trial to provide a clear surgical guideline.<BR><B>METHODS: </B>All patients in the suture flap fixation cohort from the SAM-trial were analyzed if details regarding flap fixation were available. The most optimal number of sutures was determined using a receiving operator characteristics curve. The incidence of seroma formation between patients receiving the most optimal number of sutures and patients receiving fewer sutures was compared.<BR><B>RESULTS: </B>The most optimal number of sutures proved to be 15. Patients with ≥15 sutures had a lower incidence of seroma formation at every time frame during follow-up. There was a significant difference at 6 weeks (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.09-8.56), 3 months (OR: 4.62, 95% CI: 1.34-12.92), and 1 year postoperatively (OR: 20.48, 95% CI: 2.18-192.22). Ten days and 6 months postoperatively did not differ significantly.<BR><B>CONCLUSIONS: </B>Flap fixation in general, but also the surgical technique influences the incidence of seroma formation after mastectomy. Results suggest a minimum of 15 sutures, spaced approximately 3.7 cm apart.